Tomohiro Nakajima

Transmanubrial approach with video-assisted thoracoscopic surgery for left superior sulcus tumour with dense adhesion after replacement of descending thoracic aorta

There are various surgical approaches to superior sulcus tumours according to the location of the tumour. The chief difficulties in the operation are broadening of the operative field and adhesiolysis. This study presents the case of surgical treatment of superior sulcus tumour following chemoradiation therapy with dense pleural adhesion due to a history of graft replacement of the descending thoracic aorta. The patient underwent left upper lobectomy via a transmanubrial osteomuscular-sparing approach combined with video-assisted thoracoscopic surgery (VATS). Transmanubrial approach combined with VATS offered a good overview during local tumour dissection.

Surgery of giant right coronary artery aneurysm complicated with coronary artery fistula to left ventricle

Coronary artery aneurysms (CAA)may exceed 5 cm, commonly involve the right coronary artery (RCA), may occur in close proximity to the left main trunk, andmay result in pulmonary artery fistulae or compress the right atrium and present as a pericardial mass. We present images of a CAA of the RCA with a fistula to the left ventricle (LV). A 64-year-old female was evaluated for palpitations and found on computed tomography (CT) scan to have a 6-cm right CAA (RCAA)with a fistula to the posterior LV (Figures 1A and 1B). At the time of surgery, cardiopulmonary bypass was instituted by aortic and bicaval cannulation. The aorta was crossclamped and the heart arrested with retrograde cold blood cardioplegia. The RCCA was opened, the fresh clot removed, and the orifices of the branches were suture ligated (Figures 2A and 2B). The RCCA fisutula was closed with a pericardial patch and the ostium of the RCA was closed with a Dacron patch (Figure 2C). An end-side anastomosis was performed to the posteriolateral branch using a segment of saphenous vein, followed by a sideside anastomosis to the posterior descending artery, and a proximal anastomosis to the ascending aorta (Figure 2D). The patient tolerated the procedure well. A postoperative CT angiogram showed a patent vein graft and closure of the RCCA orifice and fistula (Figure 1C). The histology of the RCCA showed atherosclerotic changes and disruption of the tunica media.

Idiopathic bronchial hemorrhage: a rare but catastrophic complication in cardiac surgery.

BackgroundHemoptysis is a common complication in all kinds of surgery. However, it is rarely critical because it resolves with or without intervention.Case presentationHere the authors present what is believed to be an unprecedented report of a case involving a fatal idiopathic bronchial hemorrhage complication during cardiac surgery. Eighty-five-year-old female with severe aorticvalve stenosis had elective aortic valve replacement. Subsequently, she developed diffuse bilateral severe idiopathic bronchial hemorrhage which required maximum intervention such as external bronchial ligation, V-A ECMO, coil embolization of bronchial artery and internal airway blockage by spigot.ConclusionsAirway bleeding is not a rare complication in cardiac surgery, but this case should increase awareness of this potentially life threatening perioperative complication.

Acute Dilatation of the Ascending Aorta and Aortic Valve Regurgitation in Loeys-Dietz Syndrome

Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder caused by mutations of the transforming growth factor (TGF)-β receptors. It is an autosomal dominant syndrome characterized by the triad of arterial tortuosity and aneurysms, hypertelorism, and bifid uvula or cleft palate. We treated an 18-year-old woman with a 100-mm-diameter aortic root aneurysm and severe aortic valve regurgitation. She underwent urgent aortic root replacement and bioprosthetic valve implantation. LDS was diagnosed by postoperative genetic screening results. Histopathologic examination of the aortic wall showed diffuse degeneration and elastin fragmentation in the media.